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ACG CXA ACTUAL EXAM 2026/2027 |
Questions with Correct Answers | Grade
A+ & Verified Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: ELIGIBILITY AND ENROLLMENT (23 Questions)
Q1: A client with an estimated annual household income of $48,000 for a family of three is
applying for coverage through the Health Insurance Marketplace. The Federal Poverty Level
(FPL) for a family of three is $24,860. Which of the following statements about this client's
eligibility is correct?
A. The client is eligible for premium tax credits but not cost-sharing reductions
B. The client is eligible for both premium tax credits and cost-sharing reductions
C. The client is eligible for Medicaid based on their income level
D. The client is not eligible for any financial assistance because income exceeds 400% FPL
Correct Answer: A [CORRECT]
Rationale: The client's income is 193% of FPL ($48,000 ÷ $24,860 = 1.93 or 193%). Premium
tax credits are available for households with incomes between 100-400% FPL, making this client
eligible. However, cost-sharing reductions (CSR) are only available to Silver plan enrollees with
incomes between 100-250% FPL. While 193% FPL falls within the CSR range, the client must
actively select a Silver plan to receive CSR benefits—eligibility alone doesn't guarantee CSR.
Option B is incorrect because it assumes automatic CSR eligibility without Silver plan
enrollment. Option C is incorrect because Medicaid expansion typically covers up to 138% FPL
in expansion states, and this client exceeds that threshold. Option D is incorrect because 193%
FPL is well below the 400% FPL cap for premium tax credits.
Q2: Maria, age 29, single with no dependents, earns $32,000 annually as a freelance graphic
designer. She lives in a state that has expanded Medicaid. What is her most likely eligibility
determination for Marketplace financial assistance?
A. Eligible for Medicaid; ineligible for Marketplace subsidies
B. Eligible for premium tax credits only; ineligible for CSR
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C. Eligible for both premium tax credits and CSR if she selects a Silver plan
D. Ineligible for all coverage programs due to immigration status requirements
Correct Answer: B [CORRECT]
Rationale: Maria's income is approximately 249% of FPL for an individual ($32,000 ÷ $12,880
= 2.49). In Medicaid expansion states, the program covers individuals up to 138% FPL, so Maria
exceeds Medicaid eligibility. She qualifies for premium tax credits (100-400% FPL range).
However, CSR benefits are only available for incomes between 100-250% FPL who select Silver
plans. At 249% FPL, Maria technically qualifies for CSR, but the question asks for "most likely"
determination—at this threshold, her CSR benefits would be minimal (73% actuarial value vs.
standard 70% Silver). Option A is incorrect because she exceeds Medicaid limits. Option C
overstates the practical value of CSR at this income level. Option D is incorrect as the scenario
provides no basis for immigration status concerns.
Q3: The Johnson family (two parents, ages 38 and 40, with two children ages 8 and 12) has a
household income of $85,000. They currently have employer-sponsored coverage available
through Mr. Johnson's job, but the employee-only premium is $6,500/year and the family
premium is $18,000/year. Is this family eligible for Marketplace subsidies?
A. Yes, because the family premium exceeds 9.61% of household income
B. No, because the employee-only premium is less than 9.61% of household income
C. Yes, because they have children under age 18
D. No, because employer coverage is always considered affordable regardless of cost
Correct Answer: B [CORRECT]
Rationale: Under the ACA employer affordability test for 2026, coverage is considered
affordable if the employee-only premium does not exceed 9.61% of household income (this
percentage is indexed annually). The Johnson family's employee-only premium is $6,500, which
is 7.6% of $85,000—below the affordability threshold. When employer-sponsored coverage is
deemed affordable for the employee, the entire family is ineligible for Marketplace subsidies,
regardless of the family premium cost. This is known as the "family glitch," though recent
regulatory changes have addressed this for 2024 onward. Option A incorrectly applies the family
premium to the affordability test. Option C is irrelevant to subsidy eligibility. Option D is
incorrect because employer coverage affordability is specifically defined by percentage of
income, not automatic.
Q4: During Open Enrollment 2027, a client who is a U.S. citizen wants to enroll in a
Marketplace plan. Which documentation is NOT required as part of the standard application
process?
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A. Social Security Number
B. Proof of U.S. citizenship or lawful presence
C. Previous year's tax return
D. Employer Identification Number if self-employed
Correct Answer: C [CORRECT]
Rationale: While previous year's tax return information can be helpful for verifying income and
household composition, it is not a mandatory documentation requirement for Marketplace
enrollment. The Marketplace uses current year income projections for subsidy calculations.
Required documentation includes: Social Security Numbers for all household members applying
for coverage (Option A), proof of citizenship or lawful presence (Option B), and employer
information including EIN if applicable (Option D). The Marketplace verifies income through
electronic data sources when possible, and applicants may need to provide current pay stubs or
income verification if data conflicts exist, but historical tax returns are not standard
requirements.
Q5: A 24-year-old recent college graduate loses coverage under her parent's employer plan on
her 26th birthday, which occurs on March 15, 2027. When does her Special Enrollment Period
(SEP) begin and end?
A. Begins March 15, 2027; ends 60 days after March 15, 2027
B. Begins 60 days before March 15, 2027; ends 60 days after March 15, 2027
C. Begins March 15, 2027; ends 60 days after loss of coverage (typically the end of the month)
D. Begins 60 days before March 15, 2027; ends 60 days after the end of the month in which
coverage was lost
Correct Answer: D [CORRECT]
Rationale: For loss of other coverage qualifying life events, the SEP begins 60 days before the
coverage loss date and extends 60 days after the coverage loss date. However, employer plans
typically terminate coverage at the end of the month in which the qualifying event occurs (age
26). Therefore, the SEP actually runs from approximately January 15 (60 days before March 15)
through approximately May 31 (60 days after March 31, assuming coverage ends March 31).
Option A is incorrect because it doesn't account for the pre-loss enrollment window. Option B
incorrectly states the end date. Option C is incorrect because it doesn't recognize the full 60-day
pre-loss window and assumes coverage ends immediately on the birthday.
Q6: Which of the following household members must be included when determining
Marketplace eligibility and subsidy calculations?
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A. A 19-year-old daughter who is married and files taxes jointly with her spouse
B. A 25-year-old son who is a full-time student and claimed as a dependent
C. A 17-year-old foster child placed in the home by the state
D. An elderly parent who lives with the family but is not claimed as a dependent
Correct Answer: B [CORRECT]
Rationale: For Marketplace purposes, household composition includes the tax filer, their spouse
if filing jointly, and all tax dependents claimed on the return. A 25-year-old full-time student who
is claimed as a dependent (eligible up to age 24 for student status, or older if permanently
disabled) would be included. Option A is incorrect because married children filing jointly with
their spouses constitute their own separate household for Marketplace purposes. Option C is
incorrect because foster children are not typically claimed as tax dependents in the same manner
and have separate eligibility pathways. Option D is incorrect because non-dependent relatives
living in the home are not part of the Marketplace household unless claimed as dependents.
Q7: A client earns $45,000 annually and has access to an employer-sponsored ICHRA
(Individual Coverage Health Reimbursement Arrangement) offering $300/month. Can this client
receive premium tax credits?
A. Yes, because ICHRA amounts are not considered employer coverage
B. No, because any ICHRA offer makes the individual ineligible for subsidies
C. Yes, if the ICHRA is considered unaffordable based on the lowest cost Silver plan premium
D. No, unless the client opts out of the ICHRA and waives all reimbursement benefits
Correct Answer: C [CORRECT]
Rationale: Starting in 2020, ICHRA arrangements allow employers to reimburse employees for
individual market premiums. An ICHRA is considered "affordable" if the amount the employee
must pay for the lowest cost Silver plan (after the ICHRA contribution) does not exceed the ACA
affordability percentage (9.61% for 2026) of household income. If the ICHRA is unaffordable,
the employee may be eligible for premium tax credits. In this case, if the lowest cost Silver plan
is $500/month and the ICHRA provides $300/month, the employee pays $200/month
($2,400/year), which is 5.3% of $45,000—potentially affordable. However, if the Silver plan
costs $700/month, the employee pays $400/month ($4,800/year = 10.7% of income), making the
ICHRA unaffordable and potentially qualifying the employee for subsidies. Option A is incorrect
because ICHRA is considered employer coverage. Option B is incorrect because unaffordable
ICHRA allows subsidy eligibility. Option D describes an outdated rule that no longer applies.
Q8: When calculating Modified Adjusted Gross Income (MAGI) for Marketplace eligibility,
which of the following is ADDED back to Adjusted Gross Income (AGI)?
ACG CXA ACTUAL EXAM 2026/2027 |
Questions with Correct Answers | Grade
A+ & Verified Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: ELIGIBILITY AND ENROLLMENT (23 Questions)
Q1: A client with an estimated annual household income of $48,000 for a family of three is
applying for coverage through the Health Insurance Marketplace. The Federal Poverty Level
(FPL) for a family of three is $24,860. Which of the following statements about this client's
eligibility is correct?
A. The client is eligible for premium tax credits but not cost-sharing reductions
B. The client is eligible for both premium tax credits and cost-sharing reductions
C. The client is eligible for Medicaid based on their income level
D. The client is not eligible for any financial assistance because income exceeds 400% FPL
Correct Answer: A [CORRECT]
Rationale: The client's income is 193% of FPL ($48,000 ÷ $24,860 = 1.93 or 193%). Premium
tax credits are available for households with incomes between 100-400% FPL, making this client
eligible. However, cost-sharing reductions (CSR) are only available to Silver plan enrollees with
incomes between 100-250% FPL. While 193% FPL falls within the CSR range, the client must
actively select a Silver plan to receive CSR benefits—eligibility alone doesn't guarantee CSR.
Option B is incorrect because it assumes automatic CSR eligibility without Silver plan
enrollment. Option C is incorrect because Medicaid expansion typically covers up to 138% FPL
in expansion states, and this client exceeds that threshold. Option D is incorrect because 193%
FPL is well below the 400% FPL cap for premium tax credits.
Q2: Maria, age 29, single with no dependents, earns $32,000 annually as a freelance graphic
designer. She lives in a state that has expanded Medicaid. What is her most likely eligibility
determination for Marketplace financial assistance?
A. Eligible for Medicaid; ineligible for Marketplace subsidies
B. Eligible for premium tax credits only; ineligible for CSR
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C. Eligible for both premium tax credits and CSR if she selects a Silver plan
D. Ineligible for all coverage programs due to immigration status requirements
Correct Answer: B [CORRECT]
Rationale: Maria's income is approximately 249% of FPL for an individual ($32,000 ÷ $12,880
= 2.49). In Medicaid expansion states, the program covers individuals up to 138% FPL, so Maria
exceeds Medicaid eligibility. She qualifies for premium tax credits (100-400% FPL range).
However, CSR benefits are only available for incomes between 100-250% FPL who select Silver
plans. At 249% FPL, Maria technically qualifies for CSR, but the question asks for "most likely"
determination—at this threshold, her CSR benefits would be minimal (73% actuarial value vs.
standard 70% Silver). Option A is incorrect because she exceeds Medicaid limits. Option C
overstates the practical value of CSR at this income level. Option D is incorrect as the scenario
provides no basis for immigration status concerns.
Q3: The Johnson family (two parents, ages 38 and 40, with two children ages 8 and 12) has a
household income of $85,000. They currently have employer-sponsored coverage available
through Mr. Johnson's job, but the employee-only premium is $6,500/year and the family
premium is $18,000/year. Is this family eligible for Marketplace subsidies?
A. Yes, because the family premium exceeds 9.61% of household income
B. No, because the employee-only premium is less than 9.61% of household income
C. Yes, because they have children under age 18
D. No, because employer coverage is always considered affordable regardless of cost
Correct Answer: B [CORRECT]
Rationale: Under the ACA employer affordability test for 2026, coverage is considered
affordable if the employee-only premium does not exceed 9.61% of household income (this
percentage is indexed annually). The Johnson family's employee-only premium is $6,500, which
is 7.6% of $85,000—below the affordability threshold. When employer-sponsored coverage is
deemed affordable for the employee, the entire family is ineligible for Marketplace subsidies,
regardless of the family premium cost. This is known as the "family glitch," though recent
regulatory changes have addressed this for 2024 onward. Option A incorrectly applies the family
premium to the affordability test. Option C is irrelevant to subsidy eligibility. Option D is
incorrect because employer coverage affordability is specifically defined by percentage of
income, not automatic.
Q4: During Open Enrollment 2027, a client who is a U.S. citizen wants to enroll in a
Marketplace plan. Which documentation is NOT required as part of the standard application
process?
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A. Social Security Number
B. Proof of U.S. citizenship or lawful presence
C. Previous year's tax return
D. Employer Identification Number if self-employed
Correct Answer: C [CORRECT]
Rationale: While previous year's tax return information can be helpful for verifying income and
household composition, it is not a mandatory documentation requirement for Marketplace
enrollment. The Marketplace uses current year income projections for subsidy calculations.
Required documentation includes: Social Security Numbers for all household members applying
for coverage (Option A), proof of citizenship or lawful presence (Option B), and employer
information including EIN if applicable (Option D). The Marketplace verifies income through
electronic data sources when possible, and applicants may need to provide current pay stubs or
income verification if data conflicts exist, but historical tax returns are not standard
requirements.
Q5: A 24-year-old recent college graduate loses coverage under her parent's employer plan on
her 26th birthday, which occurs on March 15, 2027. When does her Special Enrollment Period
(SEP) begin and end?
A. Begins March 15, 2027; ends 60 days after March 15, 2027
B. Begins 60 days before March 15, 2027; ends 60 days after March 15, 2027
C. Begins March 15, 2027; ends 60 days after loss of coverage (typically the end of the month)
D. Begins 60 days before March 15, 2027; ends 60 days after the end of the month in which
coverage was lost
Correct Answer: D [CORRECT]
Rationale: For loss of other coverage qualifying life events, the SEP begins 60 days before the
coverage loss date and extends 60 days after the coverage loss date. However, employer plans
typically terminate coverage at the end of the month in which the qualifying event occurs (age
26). Therefore, the SEP actually runs from approximately January 15 (60 days before March 15)
through approximately May 31 (60 days after March 31, assuming coverage ends March 31).
Option A is incorrect because it doesn't account for the pre-loss enrollment window. Option B
incorrectly states the end date. Option C is incorrect because it doesn't recognize the full 60-day
pre-loss window and assumes coverage ends immediately on the birthday.
Q6: Which of the following household members must be included when determining
Marketplace eligibility and subsidy calculations?
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A. A 19-year-old daughter who is married and files taxes jointly with her spouse
B. A 25-year-old son who is a full-time student and claimed as a dependent
C. A 17-year-old foster child placed in the home by the state
D. An elderly parent who lives with the family but is not claimed as a dependent
Correct Answer: B [CORRECT]
Rationale: For Marketplace purposes, household composition includes the tax filer, their spouse
if filing jointly, and all tax dependents claimed on the return. A 25-year-old full-time student who
is claimed as a dependent (eligible up to age 24 for student status, or older if permanently
disabled) would be included. Option A is incorrect because married children filing jointly with
their spouses constitute their own separate household for Marketplace purposes. Option C is
incorrect because foster children are not typically claimed as tax dependents in the same manner
and have separate eligibility pathways. Option D is incorrect because non-dependent relatives
living in the home are not part of the Marketplace household unless claimed as dependents.
Q7: A client earns $45,000 annually and has access to an employer-sponsored ICHRA
(Individual Coverage Health Reimbursement Arrangement) offering $300/month. Can this client
receive premium tax credits?
A. Yes, because ICHRA amounts are not considered employer coverage
B. No, because any ICHRA offer makes the individual ineligible for subsidies
C. Yes, if the ICHRA is considered unaffordable based on the lowest cost Silver plan premium
D. No, unless the client opts out of the ICHRA and waives all reimbursement benefits
Correct Answer: C [CORRECT]
Rationale: Starting in 2020, ICHRA arrangements allow employers to reimburse employees for
individual market premiums. An ICHRA is considered "affordable" if the amount the employee
must pay for the lowest cost Silver plan (after the ICHRA contribution) does not exceed the ACA
affordability percentage (9.61% for 2026) of household income. If the ICHRA is unaffordable,
the employee may be eligible for premium tax credits. In this case, if the lowest cost Silver plan
is $500/month and the ICHRA provides $300/month, the employee pays $200/month
($2,400/year), which is 5.3% of $45,000—potentially affordable. However, if the Silver plan
costs $700/month, the employee pays $400/month ($4,800/year = 10.7% of income), making the
ICHRA unaffordable and potentially qualifying the employee for subsidies. Option A is incorrect
because ICHRA is considered employer coverage. Option B is incorrect because unaffordable
ICHRA allows subsidy eligibility. Option D describes an outdated rule that no longer applies.
Q8: When calculating Modified Adjusted Gross Income (MAGI) for Marketplace eligibility,
which of the following is ADDED back to Adjusted Gross Income (AGI)?
